The epidemiology of head and neck cancer can be accounted for largely in terms of known carcinogens introduced into the body through the mouth. Though there are many environmental exposures--such as asbestos, radon, nickel and arsenic--which have strong carcinogenic effects, most of these have only a small impact on the general population because exposure is limited, usually to small occupational groups. Two prevalent exposures, however, tobacco and alcohol, are strong risk factors for nearly all sites in the head and neck, and together account for about 80%-90% of all cancers of the head and neck. There is evidence for biologic interaction between some occupational exposures and cigarette smoking for cancer of the lung, and tobacco and alcohol for cancer of the mouth. Based on this evidence for biologic interaction and the prevalence of smoking, it seems likely that tobacco is related to about 80% of all cancers of the head and neck in the United States.
Background
National medical/surgical organizations have recommended the use of neoadjuvant endocrine therapy (NET) to bridge surgery delay of weeks to months for patients with hormone receptor positive (HR+) breast cancer during the ongoing coronavirus disease 2019 (COVID-19) pandemic. The effects of NET of varying durations on pathologic response are unclear. Using the National Cancer Database (NCDB), we evaluated objective response to short (< 9 weeks), moderate (9–27 weeks), and long (> 27 weeks) duration of NET.
Patients and Methods
The study cohort included female patients diagnosed with nonmetastatic invasive HR+ breast cancer, stratifying by those who received NET versus no NET between 2004 and 2016. Pathologic response was grouped into four categories (complete, downstaged, stable, upstaged) by comparing clinical and pathologic staging data. Objective response to NET included complete, downstaged, and stable pathologic response. Clinical characteristics were compared using
χ
2
and analysis of variance (ANOVA) tests. Multivariable logistic regression was used to determine factors associated with NET use and objective response according to NET duration.
Results
A minority (1.2%) received NET in our cohort. Factors associated with NET use included older age, non-Black patients, more advanced clinical stage, higher comorbidity score, government insurance, and lobular histology. Objective response rate (ORR) was 56.7%, 52.1%, and 49.0% after short, moderate, and long NET duration, respectively.
Conclusion
Short NET duration did not result in an inferior ORR. Future study to evaluate the interaction between surgery delay and NET use on clinical outcome will provide insights into the safety of NET to bridge potential surgery delay in patients with HR+ breast cancer.
Supplementary Information
The online version contains supplementary material available at 10.1245/s10434-021-10287-5.
Background: The Coronavirus-2019 (COVID-19) pandemic profoundly impacted care for breast cancer patients. Oncologic and reconstructive surgeries were delayed as hospitals attempted to preserve personal protective equipment and bed capacity. Little is known about how this unprecedented time has affected breast cancer patients’ mental health and perceptions regarding their care. Methods: A survey was sent to surgical oncology and plastic surgery patients who received breast cancer care between March and May 2020, during which our institution suspended elective surgery. The survey questions included patient demographics, as well as questions focused on worries related to COVID-19, individualized cancer and reconstructive care, and patient satisfaction with telemedicine. Descriptive statistics were used to assess patient responses. Results: 56 breast cancer patients completed the survey, which reflected a 25% response rate. A majority of patients expressed moderate concern about contracting COVID-19, accessing high-quality cancer care (78%), and receiving timely surgical care (68%). Only 43% of patients reported delays in their surgical cancer and reconstructive care, when in actuality 57% of patients experienced surgical delays. Overall, patients were satisfied with telemedicine and did not feel it negatively impacted their care (69%). Conclusions: The COVID-19 pandemic has led to disruptions of routine oncologic and reconstructive care for breast cancer patients. Patients were concerned about receiving high-quality cancer and reconstructive care, and the results of this study uncovered gaps in patient–physician communication. The implementation of telemedicine was received positively. These data can be used to improve future health system practices as the medical community faces new potential shutdowns of surgical services.
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